On the Shoulders of Giants

Spoon FeedSpinal cord injury without radiographic abnormality (SCIWORA) was very rare, 27/34069 (0.08%). Although NEXUS enrolled 3000 patients <18 years, down to age 1, all patients with SCIWORA were adults in this cohort.

Why does this matter?SCIWORA is more commonly thought to be a pediatric trauma phenomenon. The term was coined in 1982 when patients were described with obvious signs of spinal cord injury but no c-spine fractures or subluxation. It is important to know about this entity and do a careful neurological exam on patients with negative c-spine imaging. Any abnormality on exam warrants MRI, spine specialist consultation, and rigid collar immobilization.

NEXUS on the list - SCIWORAIn the multi-center, prospective, very large NEXUS trial, 818/34069 (2.4%) patients had c-spine injury. Only 27/34069 (0.08%) had SCIWORA. On MRI, most of them had findings of central disc bulge, spinal stenosis, cord edema or contusion. Ten people had central cord syndrome. Oddly, all SCIWORA injuries were in adults, which is contrary to expectation, as we usually think of it as a pediatric disease. This changed the way we think about this disease entity, as prior studies were retrospective and likely subject to referral bias. SCIWORA was extremely rare and even less common in children than previously thought. Disc disease and cervical stenosis appeared to increase risk for SCIWORA.